Here's Why Your Shoulder Hurts So Damn Bad When You Lift

No pain, no gain. It's a common phrase most lifters live by. But when it comes to lifting and shoulder pain, it could signal something more serious than the run-of-the mill muscle soreness you’d experience after a tough workout.

One big one? An injury to your rotator cuff, a group of four muscles and tendons that keeps your shoulder’s ball joint centered on its socket joint. Its primary function is to help initiate movements of larger muscles, like your deltoids, says Christopher Camp, M.D., an orthopedic surgeon at the Mayo Clinic. It helps you rotate and raise your arm.

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You don’t need to be a world-class athlete—think major league pitcher—to develop some serious issues with your rotator cuff. Even casual lifters can fall prey to rotator cuff injuries.

So here’s everything you need to know about them—and how you can stop your shoulder from hurting, fast.

Rotator Cuff Injury Symptoms

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If you're experiencing any shoulder pain, it's a sign something is wrong.

"It is critical for weightlifting enthusiasts to know that any pain in the shoulder is not normal, especially acute pain that occurs after a single lift," says Dr. Camp. That means any pain that rears up after something specific—say, a lateral raise or shoulder press—could be signaling an injury to your rotator cuff.

The pain you’d feel would be like a toothache, according to the Cleveland Clinic. That means it would be a radiating discomfort, usually from your outer arm to a little below the top of your shoulder. It’s usually made worse if you raise your arms above your head or reach behind your body, like if you were passing a belt through your belt loops. You might even hear a clicking noise when you lift your arms, too.

How to Know If You Tore Your Rotator Cuff

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But don’t jump to the assumption that you necessarily tore your rotator cuff, a severe injury that occurs when your tendon is actually ripped away from your bone.

In fact, the most common kind of injury to the rotator cuff in casual lifters is something called rotator cuff tendinitis, an inflammation or swelling of the tendons connecting your muscles and bones in your shoulder, says Lawrence V. Gulotta, M.D., an orthopedic surgeon at the Hospital for Special Surgery in New York City. It often occurs due to overworking your delts at the gym, like with too many or too heavy rear delt flys or shoulder presses.

If you had an actual rotator cuff tear, your pain will be more severe.

"Symptoms that would point to a tear are severe pain and weakness. The pain is typically located on the outside of the shoulder," says Dr. Gulotta. Plus, it’s usually worse at night, and you might not be able to lift your arms above your head or lift things away from your body.

How to Prevent Rotator Cuff Injuries

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You can prevent rotator cuff tendonitis by balancing your workout.

"The rotator cuff and deltoid muscles are antagonists and should always be worked out in combination with each other," says Dr. Gulotta. "Failure to do so may lead to imbalances around the shoulder that cause tendinitis from overuse of the rotator cuff.”

When it comes to avoiding rotator cuff injury when lifting, it's all about using the appropriate weight and form.

"Although rotator cuff injuries can happen a number of different ways, they most commonly occur when trying to lift heavy weights overhead," says Dr. Camp. "For weightlifters, bench press and overhead (military) press are probably the most common culprits."

Now, that doesn’t mean you shouldn’t do these lifts, of course. Just make sure that your form is on target—say, you’re keeping your elbows at an angle in front of your body instead of directly out to the sides when you’re pressing. Going wide will allow you to press more weight, but will add stress to your rotator cuff.

And stay on form throughout your entire set, too: "In my practice, the most common way people tear their rotator cuff while working out is when they do not pay attention to their form while trying to get one last rep in," says Dr. Gulotta. "The one thing they all have in common is that the main muscles lose control due to fatigue, putting a lot of stress on the rotator cuff causing it to tear."

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It’s not just about form, either—you need to make sure you’re lifting a safe amount of weight. Plus, since your shoulders are endurance muscles, you don’t need a lot of weight to make them grow, says Dr. Camp. Lighter weight, higher reps can do the trick, and keep your rotator cuff safe at the same time.

Plus, make sure you’re not overworking them, either. Stick to training shoulder twice a week, says Dr. Camp. (You’ll still be working your shoulder muscles when you do other lifts, too, like arm and back exercises like seated cable rows).

How to Treat Rotator Cuff Injuries

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When shoulder pain develops, the best thing to do is back off lifting for a while.

Avoid upper body lifting and apply ice two to three times a day for about 20 minutes. Take anti-inflammatory meds like ibuprofen or naproxen to relieve pain, especially if your injury is tendinitis-related, says Dr. Camp. Most milder shoulder injuries will resolve with this kind of treatment.

If pain fails to improve with these approaches after a couple weeks, something more sinister may be at play, especially if you have weakness in your arm or can’t lift it. This could be signaling a full-on torn rotator cuff, says Dr. Camp.

So see your doctor if you develop those symptoms or if the pain persists after a few weeks, he says.

Your doctor can help you pinpoint the problem and provide you with a specific diagnosis based on your symptoms, physical examination, X-rays and/or MRI. He or she can work with you and a physical therapist or trainer to develop a comprehensive treatment plan tailored to your specific problem, says Dr. Camp.

"Although most patients with rotator cuff tendinitis can be treated without surgery, those with real tears in the tendons often require surgery,” says Dr. Camp. If you have a full-blown tear, surgery usually is necessary, and recovery can take about six to nine months.

Bottom line: "With the rotator cuff, an ounce of prevention is definitely worth a pound of cure," says Dr. Camp. So to avoid an extended hiatus from lifting, make sure to lift smarter—with better form, safer weights, and less excessive volume—to prevent a rotator cuff injury from occurring in the first place.

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